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How Medicare rebate cuts may impact the patient, other than cost

In her previous article Robyn Oyeniyi looked at the financial aspects of the proposed cuts to the Medicare rebate. This article assumes knowledge of the previous article. There are non-financial impacts we seriously need to consider. In this article Robyn looks at Continuing Professional Development (a doctor impact) and treatment delay (a patient and community impact).

Policies, based only on financial considerations, that discourage people from seeking treatment at the earliest (and therefore cheapest) opportunity are knee-jerk reactions at a momentary point in time with no thought for the future or the non-financial impact of those policies. Research shows such short-term “savings” actually result in higher costs and sicker people in the long-term.

Medical Knowledge/Continuing Professional Development

Doctors hold our health in the palm of their hands. Yes, we, the patients, certainly have a major part to play in caring for our own health, but the reality is the doctors decide what tests to run, what medications to prescribe and whether we need to see a specialist or a surgeon.

In order for doctors to care for us in the best way possible, they can’t be consulting all the time. We expect the medical profession to keep up-to-date with advances in the field. Again I will use my own case as an example. The RF (Rheumatoid Factor) test had been the stock standard test for Rheumatoid Arthritis (RA) for many years, well over half a century. Unfortunately, specificity is not very good: IgM RF, the isotype most typically detected, is seen not only in RA but also in various other conditions. Also, some RA patients never test RF positive. There is a new (relatively speaking in research to commercially available terms) blood test, the anti-CCP with much higher specificity and in many cases earlier detection of RA. Earlier detection leads to earlier treatment resulting in better outcomes.

As a patient, you expect your doctor to know about new tests. Continuing Professional Development (CPD) takes time (up to 50 hours a year is specified in some cases) and effort and can be costly. Certainly my general practitioner may be able to learn about a new blood test from a medical journal or a medical association newsletter, but these cost. Journal subscriptions and association memberships don’t come free. There is the time required to read the information, absorb it, understand it. This is all non-revenue generating time.

What of our surgeons? New surgical techniques are constantly being developed. We can have laparoscopic hysterectomies these days, a far cry from the full abdominal cut. We want our surgeons to know the least invasive techniques, don’t we? Learning these may be a bit more time-consuming and/or expensive than reading a journal article about a new blood test.

Remember the days of “exploratory surgery”? My mother had some of that. Now with modern imaging techniques, one rarely hears the term. Yet without knowledge of these advances, our doctors would still be recommending exploratory surgery.

Doctors are no different to the rest of us. They have families, mortgages and household bills. They like to go to their children’s sports events and school concerts. Date nights with their spouse are important, just as for all of us. Doctors are normal people with normal lives. They are entitled to time off.

Yes, there are some doctors who are very rich. So are some plumbers and electricians. Most are not. Many have the added responsibility of running a business: it isn’t just the medical knowledge.

If we arbitrarily cut the gross revenue of our doctors, yet the running costs of their businesses and their family lives continue to increase in line with the overall economy, what might suffer? I suggest it might be the extra CPD most doctors do to stay abreast and that impacts on all of us. Or the study diligence will suffer, perhaps, without them even realising. My profession also requires CPD but I can tell you right now if the kids need help with homework, or the dinner needs cooking or the pantry needs restocking, my professional journal can sit untouched. They’ll do the legal requirement, of course, but is that enough to be the best when medical advances are frequent and across the breadth of medical knowledge. Will they be forced to attend cheaper courses or conferences for a lesser value learning experience?

NB: There is no intention to imply doctors would deliberately compromise their CPD.

Apart from CPD, cost pressures may force staff reductions in a practice. One nurse instead of two, or one less receptionist. How will this impact on you? Will medical practices close and the doctors change professions?

If the doctors do, as they have said they will have no option but to do, pass the cost of the lost revenue on to the patients, then we have the potential for the second consideration.

Treatment Delay versus Early Intervention

I think we all know these days that the earlier a medical condition is detected and treatment begun the better the prognosis for the patient. Breast cancer, colon cancer, rheumatoid arthritis – the list goes on. In every case you will find the words “early detection”. When the costs of a medical consultation or tests or prescriptions become a barrier to seeking medical advice, the condition worsens. Once the patient is forced through deteriorating health to finally seek treatment they may be unable to continue to work, they may die much earlier, they may need much longer and more expensive treatment. All of this is an unnecessary financial burden to the health system and consequently to the community. Not to mention the cost to children who lose parents too early or the spouse who loses a partner.

The following is about the USA experience. Is this really what we want for Australia?

The National Council on Aging found that 25 percent of people with chronic diseases delay or skip medical treatment because of costs. Families U.S.A. has also studied the effect of high deductibles and copayments on utilization. According to Kathleen Stoll, director of health policy, the danger lies in “small medical problems becoming large medical problems, one of the many high-deductible pitfalls that consumers need to watch out for.”

Source: http://www.managedcaremag.com/archives/1001/1001.downstream.html

Here is a similar study involving children in the Philippines.

In relation to maternal health, the United Nations says:

It is often said that maternal mortality is overwhelmingly due to a number of interrelated delays which ultimately prevent a pregnant women accessing the health care she needs. Each delay is closely related to services, goods, facilities and conditions which are important elements of the right to health (see Box 4).

Source: http://www.unfpa.org/sites/default/files/pub-pdf/reducing_mm.pdf Page 8

Delays

Is this what we want for Australia? The word cost is up there in the top left-hand square.

What other non-financial impacts can you contribute to the discussion? I am sure there are many, many more.

Have you, or anyone you know, already ever delayed seeing a doctor due to the cost or fear of the cost of any treatment? Please share your experience.

This was an edited version of How Medicare Rebate cuts may impact the patient, other than cost from Robyn’s website Love versus Goliath : A Partner Visa Journey.

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8 comments

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  1. Brian Leonard

    And is this not also an invitation to drug companies to provide “education” to our doctors that will no doubt influence their prescribing habits. And where does that road lead I wonder?

  2. halsaul

    It will lead to higher prices for medication and more profits for the drug Corps. – isn’t that what destroying Medicare is all about? Abbott government would give Australia all the inadequacy & inequality of U.S.A. system. Are voters really stupid enough to go along with it?

  3. Kerri

    Or to give a more extreme example. Our present pro active medical system is precisely why diseases like Avian flu, swine flu and Ebola do not flourish. We have the technology and most importantly the knowledge and practices to avoid the rapid spread of virulent disease. Doctors need to keep on top of new diseases and we need the mechanisms for rapid diagnosis to avoid spread.

  4. Anomander

    Unfortunately, there seems to be a large section of the community who have fallen under the spell of the oft-repeated leoliberalist lie – that they shouldn’t have to pay for services they don’t use, or to pay for other people.

    Not once do they ever consider the only reason we have roads, schools, hospitals, police, and services is because everyone contributes to deliver services that benefit everyone, rather than a select few.

    What scares me the most is the havoc Abbott’s mob will wreak over the next few years, decimating our infrastructure and our services, and once they are gone, we will have buckley’s chance of getting them back again.

  5. Anomander

    Sorry Robyn, I forgot to add – fantastic series of articles that need to be spread far and wide. Please keep-up the great work and continue the fight.

  6. Team Oyeniyi

    Thank you Anomander. 🙂

  7. Kaye Lee

    One consequence that people are not considering is the impact on pharmacists who already act as “the poor man’s doctor”. Chemists will be flooded with people bypassing the doctor. They are not trained in diagnosis and are already being asked to do monitoring and maintenance for diabetes, blood pressure etc as the government slashes what they pay them. Chemists are paid on the basis of the cheapest wholesale price that drugs can be bought at if you buy in huge bulk which has led to hundreds if not thousands of smaller community pharmacies no longer being viable and closing their doors. This will only place further pressure on them.

  8. Kaye Lee

    The more this goes on, the more it looks like the Abbott government is making decisions to reward the big pharmaceutical companies who, coincidentally, feature prominently on Tony’s pollie pedal lycra. The $20 billion research fund sounds like a cash cow for big pharma, and now Abbott is going to outsource approvals.

    “Consumer advocates say patients could be placed at risk if Australia adopts proposals to rely more heavily on foreign regulators to determine the safety of drugs and medical devices.

    The proposals have been raised in a discussion paper issued as part of a federal government review of regulation for medicines and medical devices such as breast implants and artificial hip joints.

    Consumers Health Forum chief executive Adam Stankevicius said he was concerned the government seemed “intent on meeting the demands of the drug and medical-device industries while giving scant regard to questions of consumer safety and the public interest.” ”

    http://www.smh.com.au/federal-politics/political-news/outsourcing-approvals-would-put-patients-at-risk-advocates-say-20150107-12jjze.html

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